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The Feasibility of Organ Salvage From Non—Heart-Beating Trauma Donors

The Feasibility of Organ Salvage From Non—Heart-Beating Trauma Donors Abstract Background: Blunt trauma patients without vital signs on admission are potential non—heart-beating donors. Objective: To review the feasibility of postmortem visceral perfusion and organ donation in blunt trauma patients without vital signs. Design: A retrospective case series of blunt trauma victims who were declared dead in the emergency department. Setting: A level I trauma center. Main Outcome Measures: Factors potentially precluding donation and potential donor yield. Results: The mean trauma-to-death interval was 71 minutes (<60 minutes in 57% of the cases). Injuries likely to interfere with in situ perfusion were present in 41% of the cases. The tissue donation consent rate was 45%. Assuming a similar organ donation consent rate, the potential donor yield was 9% after excluding victims who were younger than 60 years of age, warm ischemia times that were less than 60 minutes, and patients who had injuries precluding perfusion. Conclusions: The potential organ yield from non—heart-beating, blunt trauma victims is low, which highlights the ethical and legal problems of this approach.Arch Surg. 1996;131:929-934 References 1. Caplan AL, Smirnoff L, Arnold R, Vernig B. Increasing organ and tissue donation: what are the obstacles, what are the options? In: Novello A, ed. Surgeon General's Workshop on Increasing Organ Donations . Washington, DC: US Dept of Health and Human Services; 1992:199-232. 2. Virnig BA, Caplan AL. Required request: what difference has it made? Transplant Proc . 1992;24:2155-2158. 3. Nathan HM, Jarrell BE, Broznik B, et al. Estimation and characterization of the potential renal organ donor pool in Pennsylvania: report of the Pennsylvania Statewide Donor Study . Transplantation . 1991;51:142-149.Crossref 4. Evans RW. Orians CE, Ascher NL. The potential supply of organ donors: an assessment of the efficacy of organ procurement efforts in the United States . JAMA . 1992;267:239-246.Crossref 5. Kootstra G, Wijnen R, van Hooff JP, van der Linden CJ. Twenty percent more kidneys through a non—heart beating program . Transplant Proc . 1991;23:910-911. 6. Hoshinaga K, Fujita T, Naide Y, et al. The non—heart-beating donor: early prognosis of 263 renal allografts harvested from non—heart-beating cadavers using an in situ cooling technique . Transplant Proc . 1995;27:703-706. 7. Wijnen RMH, Booster MH, Stubenitsky BM, et al. Outcome of transplantation of non—heart-beating donor kidneys . Lancet . 1995;345:1067-1070.Crossref 8. Valero R, Manyalich M, Cabrer C, et al. Organ procurement from non—heart-beating donors by total body cooling . Transplant Proc . 1993;25:3091-3092. 9. Varty K, Veitch PS, Morgan JD, et al. Response to organ shortage: kidney retrieval programme using non-heart beating donors . Br Med J . 1994;308:575.Crossref 10. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment . J Trauma . 1995;38:185-193.Crossref 11. Orloff MS, Reed AI, Erturk E, Kruk RAI. Nonheartbeating cadaveric organ donation . Ann Surg . 1994;220:578-585.Crossref 12. Shaw BW Jr. Conflict of interest in the procurement of organs from cadavers following withdrawal of life support . Kennedy Inst Ethics J . 1993;3:179-187.Crossref 13. National Safety Council. National Safety Council Accident Facts . Chicago, Ill: National Safety Council; 1987. 14. Anaise D, Smith R, Ishimaru M, et al. An approach to organ salvage from non-heartbeating cadaver donors under existing legal and ethical requirements for transplantation . Transplantation . 1990;49:290-294.Crossref 15. Rapaport FT, Anaise D. Technical aspects of organ procurement from the non—heart-beating cadaver donor for clinical transplantation . Transplant Proc . 1993; 25:1507-1508. 16. Boyd M, Vanek VW, Bourguet CC. Emergency room resuscitative thoracotomy: when is it indicated? J Trauma . 1992;33:714-721.Crossref 17. Morpurgo E, Rigotti P, Ancona E. Is warm ischemia the main limiting factor in the use of non—heart-beating donors in renal transplantation? Transplant Proc . 1993;25:1509-1510. 18. Alexander JW, Vaughn WK. The use of 'marginal' donors for organ transplantation: the influence of donor age on outcome . Transplantation . 1991;51:135-141.Crossref 19. Alexander JW, Vaughn WK, Carey MA. The use of marginal donors for organ transplantation: the older and younger donors . Transplant Proc . 1991;23:905-909. 20. Booster MH, Wijnen RMH, Vroemen JPAM, et al. In situ preservation of kidneys from non—heart-beating donors: a proposal for a standardized protocol . Transplantation . 1993;56:613-617.Crossref 21. Youngner SJ, Arnold RM. Ethical, psychosocial, and public policy implications of procuring organs from non—heart-beating cadaver donors . JAMA . 1993:21: 1769-2774. 22. Management of terminally ill patients who may become organ donors after death . Kennedy Inst Ethics J . 1993;3:A1-A15.Crossref 23. Childress JF. Non—heart-beating donors of organs: are the distinctions between direct and indirect effects and between killing and letting die relevant and helpful? Kennedy Inst Ethics J . 1993;3:203-216.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Feasibility of Organ Salvage From Non—Heart-Beating Trauma Donors

Archives of Surgery , Volume 131 (9) – Sep 1, 1996

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430210027006
Publisher site
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Abstract

Abstract Background: Blunt trauma patients without vital signs on admission are potential non—heart-beating donors. Objective: To review the feasibility of postmortem visceral perfusion and organ donation in blunt trauma patients without vital signs. Design: A retrospective case series of blunt trauma victims who were declared dead in the emergency department. Setting: A level I trauma center. Main Outcome Measures: Factors potentially precluding donation and potential donor yield. Results: The mean trauma-to-death interval was 71 minutes (<60 minutes in 57% of the cases). Injuries likely to interfere with in situ perfusion were present in 41% of the cases. The tissue donation consent rate was 45%. Assuming a similar organ donation consent rate, the potential donor yield was 9% after excluding victims who were younger than 60 years of age, warm ischemia times that were less than 60 minutes, and patients who had injuries precluding perfusion. Conclusions: The potential organ yield from non—heart-beating, blunt trauma victims is low, which highlights the ethical and legal problems of this approach.Arch Surg. 1996;131:929-934 References 1. Caplan AL, Smirnoff L, Arnold R, Vernig B. Increasing organ and tissue donation: what are the obstacles, what are the options? In: Novello A, ed. Surgeon General's Workshop on Increasing Organ Donations . Washington, DC: US Dept of Health and Human Services; 1992:199-232. 2. Virnig BA, Caplan AL. Required request: what difference has it made? Transplant Proc . 1992;24:2155-2158. 3. Nathan HM, Jarrell BE, Broznik B, et al. Estimation and characterization of the potential renal organ donor pool in Pennsylvania: report of the Pennsylvania Statewide Donor Study . Transplantation . 1991;51:142-149.Crossref 4. Evans RW. Orians CE, Ascher NL. The potential supply of organ donors: an assessment of the efficacy of organ procurement efforts in the United States . JAMA . 1992;267:239-246.Crossref 5. Kootstra G, Wijnen R, van Hooff JP, van der Linden CJ. Twenty percent more kidneys through a non—heart beating program . Transplant Proc . 1991;23:910-911. 6. Hoshinaga K, Fujita T, Naide Y, et al. The non—heart-beating donor: early prognosis of 263 renal allografts harvested from non—heart-beating cadavers using an in situ cooling technique . Transplant Proc . 1995;27:703-706. 7. Wijnen RMH, Booster MH, Stubenitsky BM, et al. Outcome of transplantation of non—heart-beating donor kidneys . Lancet . 1995;345:1067-1070.Crossref 8. Valero R, Manyalich M, Cabrer C, et al. Organ procurement from non—heart-beating donors by total body cooling . Transplant Proc . 1993;25:3091-3092. 9. Varty K, Veitch PS, Morgan JD, et al. Response to organ shortage: kidney retrieval programme using non-heart beating donors . Br Med J . 1994;308:575.Crossref 10. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment . J Trauma . 1995;38:185-193.Crossref 11. Orloff MS, Reed AI, Erturk E, Kruk RAI. Nonheartbeating cadaveric organ donation . Ann Surg . 1994;220:578-585.Crossref 12. Shaw BW Jr. Conflict of interest in the procurement of organs from cadavers following withdrawal of life support . Kennedy Inst Ethics J . 1993;3:179-187.Crossref 13. National Safety Council. National Safety Council Accident Facts . Chicago, Ill: National Safety Council; 1987. 14. Anaise D, Smith R, Ishimaru M, et al. An approach to organ salvage from non-heartbeating cadaver donors under existing legal and ethical requirements for transplantation . Transplantation . 1990;49:290-294.Crossref 15. Rapaport FT, Anaise D. Technical aspects of organ procurement from the non—heart-beating cadaver donor for clinical transplantation . Transplant Proc . 1993; 25:1507-1508. 16. Boyd M, Vanek VW, Bourguet CC. Emergency room resuscitative thoracotomy: when is it indicated? J Trauma . 1992;33:714-721.Crossref 17. Morpurgo E, Rigotti P, Ancona E. Is warm ischemia the main limiting factor in the use of non—heart-beating donors in renal transplantation? Transplant Proc . 1993;25:1509-1510. 18. Alexander JW, Vaughn WK. The use of 'marginal' donors for organ transplantation: the influence of donor age on outcome . Transplantation . 1991;51:135-141.Crossref 19. Alexander JW, Vaughn WK, Carey MA. The use of marginal donors for organ transplantation: the older and younger donors . Transplant Proc . 1991;23:905-909. 20. Booster MH, Wijnen RMH, Vroemen JPAM, et al. In situ preservation of kidneys from non—heart-beating donors: a proposal for a standardized protocol . Transplantation . 1993;56:613-617.Crossref 21. Youngner SJ, Arnold RM. Ethical, psychosocial, and public policy implications of procuring organs from non—heart-beating cadaver donors . JAMA . 1993:21: 1769-2774. 22. Management of terminally ill patients who may become organ donors after death . Kennedy Inst Ethics J . 1993;3:A1-A15.Crossref 23. Childress JF. Non—heart-beating donors of organs: are the distinctions between direct and indirect effects and between killing and letting die relevant and helpful? Kennedy Inst Ethics J . 1993;3:203-216.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1996

References